Aortic valve sclerosis (AVS) is associated with myocardial infarction and mortality. Since it is not cost effective to test all patients with AVS for coronary artery disease (CAD), the identification of high-risk patients is important. We developed a morphologic classification system for AVS by transesophageal echocardiography and correlated the subtypes of AVS with the presence of cardiovascular disease. AVS in general was not associated with CAD. However, among patients with mixed nodular and diffuse AVS, the prevalence of CAD and previous coronary artery bypass graft surgery were higher than among those without this mixed type (p = 0.02 and 0.008, respectively). We concluded that the finding of mixed nodular and diffuse AVS identifies patients at increased risk for CAD. Thus, the echocardiographic assessment of AVS morphology is of clinical relevance.